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Permittee Contact: <br />/� /� <br />D t rrer1 C J�'..,6 A <br />Permittee Company: <br />/ q ,{ _ / / <br />4 G A- - /e1- C.4 GAGi / Gn <br />Address: <br />&X 7 9O S <br />574,-1,77 C re 757 <br />Phone Number: <br />270 -5 . 2_.-- X6/7 <br />Fax Number: <br />,70 — 7 -3 <br />Email Address: <br />/ <br />Gfe .�' �ar`T �imami- 'rsa�iar <br />/ -Ir.S , czA-, <br />13. Attach a map to this report that accurately depicts the permit boundary, current affected area boundary and <br />location of the acreages specified in items 7- 12 and 14. Please check the appropriate response below: <br />UPDATED MAP ATTACHED: CONDITIONS UNCHAGED - PREVIOUS MAP ACCURATE: )C <br />14. Is weed control being conducted in accordance with an approved Weed Control Plan? YES NO N/A <br />If "YES ", indicate the weed species, control area, control type, application rate and treatment dat on the <br />report map. <br />15. Is adequate topsoil reserved for reclamation, based on your approved permit? <br />If "NO ", please explain: <br />16. Is the reserved topsoil vegetated /stabilized in accordance with Rule 3.1.9(1)? <br />If "NO" please explain: <br />17. If mining has exposed groundwater, is the site in compliance with the approved mining plan and Office of the <br />State Engineer (Well Permit, S.W.S.P., and /or Permanent Augmentation Plan)? NO N/A <br />18. Are all hazardous materials stored within approved spill containment structures? NO N/A <br />19. Is your financial warranty value sufficient to cover the cost to complete reclamation? NO N/A <br />20. Is your basis for legal right to enter is still valid? NO <br />YES nO N/A <br />21. Does your permit require you to submit monitoring information annually? <br />If "Yes ", please attach the required monitoring results to this annual report. <br />Please provide current contact information: <br />YES NO <br />NO N/A <br />I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site <br />operations are being conducted in accordance with the Division approved mining and reclamation plans. <br />_2-2` /(— ---- <br />Signature of Corporate Officer, Owner, or Documented Designee Date <br />